Comparing Resident Self-Report to Chart Audits for Quality Improvement Projects: Accurate Reflection or...

Area of Science:

• Medical Education
• Quality Improvement
• Primary Care

Background:

• Graduate medical education requires resident participation in quality improvement (QI).
• Effective methods for instructing and evaluating resident QI progress are not well-established.
• Accurate assessment of resident adherence to clinical guidelines is essential for patient care.

Purpose of the Study:

• To assess the reliability of self-reported chart audits.
• To compare resident self-assessments with external audits of guideline adherence.
• To inform best practices for evaluating resident performance in QI.

Main Methods:

• Internal medicine residents conducted self-reported chart audits on 10 patients each.
• Audits focused on adherence to 16 US Preventive Services Task Force guidelines.
• Resident self-reports were compared against independent external audits of 70 randomly selected charts.

Main Results:

• Self-reported adherence (82%) was significantly higher than external audit findings (68%).
• External audits revealed lower adherence for 5 key guidelines, including vaccinations and screenings.
• Third-year residents self-reported better adherence, but external audits showed lower performance compared to second-year residents.

Conclusions:

• Resident self-reported chart audits may inflate perceived adherence to clinical guidelines.
• Independent chart review and increased supervision are necessary for accurate resident performance evaluation.
• Findings highlight the need for robust methods to ensure the validity of QI assessments in medical training.